"There are some unusual legal and professional conundrums that
you come up against in this type of treatment," said Dr. Mark
McClung, who directs psychiatric treatment at the Special Commitment
Center, McNeil Island, Wash., and is a psychiatrist in private practice
in Seattle.

The SCC in Washington was created after the state legislature
passed its sexually violent predator law in 1989, following several
highly publicized sexual assaults and sexually motivated homicides. The
legislature cited the need for a commitment law for a "small but
extremely dangerous group of sexually violent predators" who did
not have a mental disease under the existing involuntary commitment act.

There are currently 127 male and 1 female sexual predators on the
SCC unit at McNeil Island, ranging in age from 18 to 70 years. Sixty
percent of the residents, mostly rapists and pedophiles, have chosen to
participate in sex offender treatment, and 30% are on psychotropic medication. Six have been released by court order and are living in
different community settings, either assisted residential living or with
family members, Dr. McClung said at the annual meeting of the American
College of Forensic Psychiatry.

Antiandrogens are an accepted part of sexual offender treatment at
SCC. Studies show these medications lower "reoffense" rates in
sexual predators up to 9 years, Dr. McClung said. However, patients and
their attorneys sometimes request or demand treatment with antiandrogens
for the purpose of being released early, rather than recovery "Does
an offender have an absolute right to be placed on antiandrogens?"
Dr. McClung asked.

Such questions are difficult to resolve. He has found that
antiandrogens are most helpful when administered near the of
Fender's release date. The decision of whether to prescribe them
should often be made on a case-by-case basis.

About 40 residents at SCC are receiving psychotropic medication for
Axis I disorders, including paraphilia. A minority has compliance
problems, and whether or not they should be involuntarily medicated has
occasionally had to be resolved by the state's courts.

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